冠状静脉窦逆行灌注血管内皮生长因子基因对心肌梗死兔心电稳定性的影响

Effect of retrograde coronary sinus perfusion pAdtrackCMV-VEGF_(165) on electrical stability of ischemic ventricular myocardium in rabbit infarction model

目的观察经冠状静脉窦逆行灌注血管内皮生长因子基因(pAdtrackCMV-VEGF165)对心肌梗死兔心电稳定性的影响。方法20只新西兰大白兔随机分为实验组(基因治疗组)和对照组,两组动物常规全麻,暴露心脏,结扎左室支建立心肌梗死模型,冠状静脉窦插管,实验组逆行灌注pAdtrackCMV-VEGF165,对照组以生理盐水对照,2周后于右室心尖部及流出道行心内程序刺激,观察心律失常诱发情况,并检测左室前壁心肌血管密度。结果对照组恶性心律失常的诱发率显著高于实验组(77.78%vs30.00%,P<0.01);基因治疗组心肌血管密度明显高于对照组(P<0.01)。结论经冠状静脉窦逆行灌注pAdtrackCMV-VEGF165可增加缺血心肌内血管密度,提高缺血心肌的心电稳定性,减少严重心律失常的发生。

Objective To compare the electrical stability of ischemic ventricular myocardium in rabbit infarction model with or without vascular endothelial growth factor （VEGF）. Methods Twenty Newzland rabbits were divided into 2 groups, general anesthesia and open thorax, elevating the apex of the heart, clamping the main stem of left ventricular coronary. pAdtrackCMV-VEGFl65 were retrograde perfused through coronary sinus in experiment group, and nature saline was used in control group. Multi-step programmed electrical stimulation was performed in right ventricular apex and outflow tract in all rabbits 2 weeks later. The instances of malignant arrhythmia, capillary density were detected. Results The instance of malignant arrhythmia induced in control group was significantly higher than that in experiment group（77.78% vs 30.00% ,P 〈0.01 ）. Meanwhile,the capillary density of the ischemic zone in gene therapy group was much more than that in control group（P 〈 0.05 ）. Conclusion Retrograde coronary sinus perfusion pAdtrackCMV-VEGFl65 can improve the capillary density of the ischemic myocardium as well as the ventricular electrical stability ,and thus decrease the incidence of malignant arrhythmia.